Case Study

Medi-Cal Reimbursement Recovery of $l Million


This district hospital with skilled nursing facility (SNF) and rural health clinics (RHCs) is located in a rural area of California's Central Valley.


HFS Consultants recovered approximately $1,000,000 over five years by appealing Medi-Cal cost report audit adjustments made by the State of California. HFS Consultants prepared documentation and position statements, conducted the informal level appeals, assisted legal counsel in the formal level appeals, estimated the recoveries for the hospital's annual CPA audits, and verified the actual cash received. The adjustments at issue had to do with allow-ability of costs, overhead cost allocations and discrete costing. Particular focus of both HFS Consultants and the State was on the SNF and RHC, which both have high Medi-Cal utilization. HFS Consultants achieved substantial results at the informal level appeal, which saved the hospital legal fees for the formal level appeal.


The client is extremely pleased with HFS Consultants' service and continues to enlist their aid each year.


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